Doctors and nurses play a pivotal role in the delivery of medical care in Australia. Having an adequate supply of highly trained health professionals is vital not only to the health of the population, but also Australia’s social and economic well-being.

Although the health workforce has been growing at a faster rate than the population, (Endnote 1) increased demand for health services has put pressure on the sector. One of the main contributors to this pressure is Australia's changing demography, particularly an ageing population and an ageing health workforce. (Endnote 2)

Providing health services across Australia's vast land mass creates additional and complex challenges, with access to health care in regional and remote areas being an ongoing issue.(Endnote 3) Australia's current health workforce is highly reliant on immigration for doctors and nurses.(Endnote 2) and while the recruitment of international medical graduates from overseas has helped with shortages, (Endnote 4)ensuring that Australia becomes more self-sufficient in the provision of qualified health professionals is important for the future of the workforce. (Endnote 4)

Using data from the 2011 Census of Population and Housing, this article examines the characteristics of doctors and nurses working in Australia, including their demographic characteristics, working arrangements and geographic distribution. The article also examines the supply of doctors and nurses, and the future of the workforce.

HOW MANY DOCTORS AND NURSES?

In 2011, there were 70,200 medical practitioners (doctors) identified by the Census of Population and Housing currently working in Australia, which includes 43,400 general practitioners (GPs) and 25,400 specialist medical practitioners (specialists). The number of GPs and specialists has increased in the last ten years, from 32,000 and 15,900 respectively in 2001.

There were 257,200 nurses in 2011 working in Australia, most of whom were registered nurses (80%), along with enrolled and mothercraft nurses(7%) and midwives (5%). The overall number of nurses has increased by more than a third in the last decade, up from 191,100 in 2001.

NUMBER OF GPS, SPECIALISTS AND NURSES - 2001 AND 2011

2001

2011

Average Annual Increase (%)

General Practitioners

32,000

43,400

3.1

Specialists(a)

15,900

25,400

4.8

Nurses

191,100

257,200

3.0

Australia

18,769,200

21,507,700

1.4

(a) Excludes Medical Practitioners not further defined.Source: ABS 2001 and 2011 Census of Population and Housing

Are there more male doctors than female doctors?

Historically, there have always been many more male than female doctors. In 1986, a quarter (25%) of GPs and less than one in six (16%) specialists were women. While male doctors continue to outnumber their female counterparts, the difference now is far less pronounced. In 2011, 43% of GPs and around one third (34%) of specialists were women.

In 2011, surgeons were predominately male, with the vast majority (94%) of orthopaedic surgeons, and around nine in ten vascular (89%) and cardiothoracic (88%) surgeons being men. The lifestyle associated with surgery, including long working hours and additional years of training are some of the reasons doctors may not specialise in surgery. (Endnote 5) This may be more so for women, who may require more flexibility to balance to work and family responsibilities.

There were, however, a small number of specialisations in which more women were practicing than men. These included endocrinologists (59%), pathologists (58%), and paediatricians (53%), and around half of rheumatologists (50%) and obstetricians and gynaecologists (49%) were women.

How old are doctors?

There were considerable differences in the age distribution of men and women doctors. While the overall proportion of female doctors has increased in recent decades, this proportion declines with age. In 2011, female doctors outnumbered male doctors among the younger cohort, with 57% of doctors aged under 30 years being women. The proportion of doctors who were women declined with age however, decreasing to just 14% by the age of 65 years.

In contrast, the distribution of male doctors was quite evenly spread across the age groups, even in the older age groups, with one in ten (11%) male doctors aged over 65 years.

NUMBER OF DOCTORS BY AGE AND SEX - 2011Source: ABS 2011 Census of Population and Housing

A similar pattern in the age distribution was seen in 2001, and the proportion of female doctors has increased across all age groups since then. With more women training to be doctors, this gender shift within the profession could continue in the future.

PROPORTION OF DOCTORS WHO WERE WOMEN BY AGE - 2001 AND 2011Source: ABS 2011 Census of Population and Housing

Is nursing dominated by women?

For many years, the image of a nurse has been female, and in 2011 nine out of ten (90%) nurses were in fact women, a slight decrease from 2001 (91%).

However, while only 10% of nurses were men, certain areas of nursing had higher proportions of male nurses than others. In 2011, one third (33%) of registered nurses working in mental health, and over a quarter (28%) of registered nurses working in the developmental disability area, were male. This is slightly lower to the proportions found in 2001 (35% and 31% respectively).

How old are nurses?

The age distribution of nurses has changed over the past decade, with increased numbers of nurses in the older age groups. In 2001, one in five (19%) nurses were aged 40-44 years, making this the largest age group, followed by those aged 45-49 years. By 2011 however, nurses aged 50-54 years made up the largest age group (16%) followed by those aged under 30 years (15%). There were also considerable increases amongst those aged over 55 years, from 11% in 2001 to 21% in 2011.

Government initiatives to support nurses in returning to work who may have otherwise ceased nursing work, along with increasing the number of nurse education and training places, may have helped to boost the overall numbers of nurses. (Endnote 6)

PROPORTION OF NURSES BY AGE - 2001 AND 2011Source: ABS 2001 and 2011 Census of Population and Housing

Is the health workforce ageing?

There has been little change in the median age of doctors over the past decade. In 2011, the median age of GPs was 43 years, an increase of one year since 2001. The median age of specialists was slightly higher (44 years) in 2011, a slight decrease from 2001 (45 years). There was some difference in the median age of nurses, rising from 42 years in 2001 to 45 years in 2011. This is due in part to higher numbers of nurses working in the older age groups.

While the median age of doctors and nurses has seen some change between 2001 and 2011, the proportion of GPs and nurses who were approaching retirement age has increased. In 2001, the proportion of all GPs aged over 50 years was 29%, higher for specialists (36%), and for nurses, one in four(23%). By 2011, the proportion of GPs and nurses aged 50 years and over had increased to over one third (35% and 37% respectively), while for specialists, the proportion remained steady at 36%.Men working in certain specialisations were even more likely to be working beyond 65 years of age, including specialist physicians (24%), psychiatrists (17%), and neurologists (14%).

HOW MANY HOURS DO DOCTORS AND NURSES WORK?

GPs worked an average of 42 hours in the week prior to the 2011 Census, three hours less than the average for specialists (45 hours). In comparison, people employed in occupations other than GPs and specialists worked an average of 37 hours in the week prior to the 2011 Census.

The hours worked by doctors varied considerably between men and women. As in many occupations, female doctors were more likely to work part-time than their male counterparts. In 2011, in the week preceding the Census, around a third of female GPs (35%) and specialists (33%) were working part time. In comparison, around one in ten male GPs or specialists worked part-time in that week (both 13%).

More male doctors work long hours

Male doctors were much more likely to work long hours, with 17% of male GPs and a quarter (25%) of male specialists working 60 hours or more prior to the 2011 Census week. In comparison, 9% of female GPs and 12% of female specialists worked more than 60 hours. Among male specialists, obstetricians, cardiologists and surgeons (including neurosurgeons, paediatric surgeons, and cardiothoracic surgeons ) were particularly likely to be working long hours.

In comparison, around one in ten (11%) men and 4% of women employed in occupations other than GPs and specialists worked 60 hours or more in the week prior to the 2011 Census.
In 2011, a considerable proportion of doctors aged 50 years or more were working part-time. This was particularly so for female doctors, of whom 42% were working part-time, compared to 20% of male doctors aged 50 years or more.

More nurses work part-time

Nurses worked an average of 33 hours in the week preceding the 2011 Census. Around half (51%) of female nurses and one quarter (26%) of male nurses worked part-time in the week prior to the Census.
The number of hours worked by female nurses differed by age, with only a third (36%) of young nurses (aged less then 30 years) working part-time, compared with almost two thirds (62%) of those aged 60 years and over.

AVERAGE HOURS WORKED(a) - 2011

(a) Mean number of hours worked in the week preceding the 2011 Census of Population and Housing.Source: ABS 2011 Census of Population and Housing,

HOW MUCH DO DOCTORS AND NURSES EARN?

Individual earnings for employees tend to vary widely according to the number of hours worked, the type of work done, the level of experience and the level of responsibility associated with a job.

According to the 2012 ABS Survey of Employee Earnings and Hours, full-time doctors in non-managerial positions earned $2,862.30 per week on average. Male doctors earned on average $3,015.60, compared with female doctors who earned $2,644.10. The equivalent earnings of all occupations was $1,471.70 for men and $1,226.40 for women.

And nurses?

In 2012, full-time nursing and midwifery professionals in non-managerial positions earned $1,633.50 per week on average. Male midwifery and nursing professionals earned $1,759.40 per week on average compared with $1,611.40 for women. Enrolled nurses earned on average $1,155.60 per week, with little difference between the earnings of men and women. This lower income reflects their relative level of qualifications within the nursing profession.

IS THERE A SUFFICIENT SUPPLY OF DOCTORS AND NURSES?

While there is no nationally recognised 'ideal' medical workforce to population ratio, (Endnote 7) increases in the ratio of doctors and nurses to the population over the past decade provide a sign that initiatives to increase supply are having some effect. However, the medical workforce remains unevenly distributed between the states and territories, and particularly between major cities and remote areas.

The number of doctors and nurses compared to the size of the Australian population has increased in the ten years to 2011. Since 2001, the per capita rate of GPs to population increased from 170.5 to 201.9 GPs per 100,000 persons. The rate per capita of specialists increased from 84.6 to 117.9 per 100,000 persons, and the rate of nurses increased from 1,018.2to 1,195.8 per 100,000 persons.

NUMBER PER 100,000 POPULATION BY HEALTH OCCUPATION - 2001 AND 2011(a) Total doctors includes GPs, specialists and medical practitioners not further defined.Source: ABS 2001 and 2011 Census of Population and Housing

States and Territories

The use of doctors and nurses in a particular State or Territory is not restricted to people who live in those States and Territories. People can travel to the closest, or most appropriate, health service, regardless of where they live. However the ratio of doctors and nurses to the population of a State or Territory gives an indication of the availability of doctors and nurses within that State or Territory.

In 2011, the Northern Territory had the highest rate of medical practitioners overall, with a per capita rate of 377.0 doctors per 100,000 persons, followed by the ACT (371.2 per 100,000). The ACT and South Australia had the highest per capita rates of specialists (137.5 and 134.0 per 100,000 persons respectively).

The Northern Territory had the highest per capita rate of GPs (267.1 per 100,000 persons), followed by the ACT (224.5 per 100,000 persons). However the Northern Territory had the lowest per capita rate of specialists (102.4 per 100,000). Western Australia had the lowest per capita rate of GPs (183.5 per 100,000 persons).

South Australia had the highest rate of nurses, with 1,451.6 per 100,000 persons, followed by the Northern Territory (1,328.2 per 100,000 persons). Western Australia had the lowest ratio of nurses, with 1,069.4 per 100,000 persons.

PER CAPITA RATIO(a) OF HEALTH PROFESSIONALS BY LOCATION(b) - 2011

NSW

VIC

QLD

SA

WA

TAS

NT

ACT

AUSTRALIA (d)(e)

GPs

198.4

197.0

201.8

217.6

183.5

197.8

267.1

224.5

201.9

Specialists

115.2

120.8

114.4

134.0

107.3

113.5

102.4

137.5

117.9

Nurses

1,098.7

1,252.5

1,165.9

1,451.6

1,069.4

1,295.2

1,328.2

1,095.7

1,195.8

Total population ('000)(c)

6,917.7

5,354.0

4,332.7

1,596.6

2,239.2

495.4

211.9

357.2

21,507.7

(a) Per 100,000 population.(b) Place of work.(c) Place of usual residence.(d) Includes Jervis Bay Territory, Christmas Island and Cocos (Keeling) Islands.(e) Includes those who did not state a place of work.Source: ABS 2011 Census of Population and Housing

WORKING IN MAJOR CITIES, REGIONAL AND REMOTE AREAS

Australia faces considerable challenges in meeting the health needs of all Australians due to the vast geography of the country, and the need to supply highly skilled health professionals to regional and remote areas. One of the most well known services delivering extensive health care and 24-hour emergency service to Australians in rural and remote areas is the Royal Flying Doctor Service. (Endnote 8)

However, despite such well respected initiatives such as the Royal Flying Doctor Service, the per capita ratio of doctors working in Australia's major cities, regional and remote areas varies considerably.

In 2011, the per capita ratio of GPs to population in major cities (227.8 per 100,000) was twice that of remote areas (113.0 per 100,000), and considerably higher than the ratio of GPs in regional areas (144.9 per 100,000).

The majority of Australia's specialists (85%) work in major cities. The ratio of specialists working in regional areas was around half (61.1 per 100,000) that of the ratio in major cities (144.1 per 100,000), while in remote areas the ratio was particularly low (15.5 per 100,000).

NUMBER OF SPECIALISTS AND GPS PER 100,000 PEOPLE BY REMOTENESS OF PLACE OF WORK - 2011(a) Includes inner and outer regional areas.(b) Includes remote and very remote areas.Source: ABS 2011 Census of Population and Housing

Travelling to a doctor

The significant difference in the location and number of doctors in regional and remote areas compared with major cities means that regional and remote patients often have to travel further than their city counterparts to access specialist doctors.In the 2010-11 ABS Patient Experience Survey, 10% of patients living in outer regional and remote areas had to travel more than one hour to access a GP, compared with just under 2% of persons living in major cities.

Doctors work longer hours outside major cities

In addition to a lower per capita ratio of medical professionals outside major cities, GPs and specialists who work in remote areas work more hours than their city counterparts. In 2011, GPs working in remote areas of Australia worked an average of 45 hours in the week before Census, compared with 43 hours for those working in regional areas and 42 hours for those in major cities. Specialists working in remote areas worked an average of 49 hours, compared with 45 hours for those in regional areas and in major cities.

Nurses

As with doctors, the per capita ratio of nurses to population in remote areas (915.4 per 100,000) was lower than in major cities (1,175.8 per 100,000) and regional areas (1,272.9 per 100,000), though not to the same extent. Unlike doctors, the ratio of nurses to population was higher in inner regional areas (1,327.4 per 100,000) than in major cities, though outer regional areas (1,161.8 per 100,000) was lower than inner regional areas and major cities.

NUMBER OF NURSES PER 100,000 PEOPLE BY REMOTENESS OF PLACE OF WORK - 2011(a) Includes remote and very remote areas.Source: ABS 2011 Census of Population and Housing

Nurses who were working in remote areas worked an average of 37 hours in the week before the Census, compared with 33 hours for those working in major cities or regional areas where nurse to population ratios were much higher.

WERE MANY DOCTORS AND NURSES BORN OVERSEAS?

The number of overseas born doctors and nurses in Australia has increased in recent years. In 2011, more than half of GPs (56%) and just under half of specialists (47%) were born overseas, up from 46% and 37% respectively in 2001. In comparison, less than a third (28%) of the total employed population in 2011 were born overseas.

One third (33%) of nurses in Australia were born overseas in 2011, compared with one quarter (25%) in 2001.

More have arrived in the last five years

The proportion of medical practitioners born overseas who were recent arrivals (that is, those who arrived to live in Australia in the preceding five years) has also increased. In 2001,12% of overseas born GPs and 15% of overseas born specialists were recent arrivals. By 2011 this had increased to around one fifth of GPs and specialists (both 19%).

The proportion of nurses born overseas who were recent arrivals also increased, from 9% in 2001 to 19% in 2011.

The increase in overseas born doctors is consistent with recent investments by Commonwealth, State and Territory governments into initiatives aimed at increasing the numbers of medical practitioners in Australia. (Endnote 4)

What countries were they born in?

Traditionally, many of Australia's overseas born doctors and nurses have come from the United Kingdom (UK), however the country of origin profile is changing. In 2001, one in five (20%) GPs and over a quarter (29%) of specialists who were born overseas were from the UK. By 2011 however, a smaller proportion of GPs (13%) and specialists (22%) were from the UK, while the proportion from India had increased. In 2011, 12% of GPs and specialists were from India, increasing from 9% and 7% respectively, in 2001.

Similarly, the proportion of overseas born nurses from the UK decreased from around one third (36%) to about one quarter (26%) between 2001 and 2011. The proportion of overseas born nurses from India increased from 2% in 2001 to 8% in 2011, one of the largest proportional increases over this period.

PROPORTION OF DOCTORS AND NURSES BORN OVERSEAS, FROM SELECTED COUNTRIES - 2011(a) Excludes Special Administrative Regions and Taiwan.Source: ABS 2011 Census of Population and Housing

BECOMING A DOCTOR OR NURSE

The number of students studying to become doctors and nurses is increasing. Higher Education enrolment statistics (Endnote 9) show thatthe number of student enrolments leading to provisional registration as a medical practitioner more than doubled from 7,900 in 2001 to 16,900 in 2011, with more women enrolled than men. The proportion of medical student enrolments that were international students increased slightly from 15% in 2001, to 18% in 2011.

More are training as a nurse

Following a period of declining nurse numbers, the 2002 Senate inquiry into nursing found that qualified nurses were in under-supply. (Endnote 10) One reason stated in the Senate inquiry report for this was the high proportion of nurses working part-time, which affects the overall labour supply of nurses, requiring more nurses to service the population. Since then, partly reflecting the introduction of initiatives to increase the number of people training to be a nurse, (Endnote 6) the number of nurses has increased, as have the number of students enrolled in nursing courses.

In 2011, there were 45,400 students enrolled in a general nursing course required for initial registration. This is twice the number of enrolments in 2001 (22,600). During this time, the proportion of nursing students who were international students has also increased, from 3% in 2001 to 15% in 2011.

LOOKING AHEAD

While the number of doctors and nurses in Australia has increased, concurrent increases in demand for health services, brought about in part by an ageing population, have escalated shortages. (Endnote 7) Numerous State, Territory and Commonwealth Governments initiatives have been introduced in response to health workforce shortages, such as the establishment of Health Workforce Australia (HWA).

HWA aims to manage reforms to Australia's health workforce, including increasing supply of the workforce through improved education and training capacity, and facilitating the recruitment of overseas trained health professionals. (Endnote 11)

There have also been increases in the number of medical school training places available, and more recently, the Australian Government announcing plans to increase the number of medical internship places. (Endnote 12) Furthermore, the Australian Government's Bonded Medical Places (BMP) Scheme aims to address shortages of medical professionals outside metropolitan areas. (Endnote 13)

ARE THEY TAKING THEIR OWN HEALTH ADVICE?

As professionals who can spend much of their time helping their patients to improve and maintain a healthy lifestyle, doctors and nurses have more knowledge than most on what can put their health at risk, and many of them were taking their own advice in 2011-12.

Most don't drink alcohol excessively
The 2009 National Health and Medical Research Council guidelines for reducing health risks associated with the consumption of alcohol state that drinking no more than two standard drinks on any day reduces the lifetime risk of harm from alcohol-related disease or injury. (Endnote 14) Around 13% of doctors and 11% of nurses did drink more than this, but compared with other workers, the proportions were much lower (23%).

Very few doctors smoke
Less than 5% of doctors were smokers, considerably lower than the rate for other workers (19%). The proportion of nurses who smoked (14%) was also less than other workers.

But more than half were overweight
Along with some other workers, many doctors and nurses were overweight or obese. More than half of doctors and nurses were overweight or obese (58% of doctors and 57% of nurses), compared with 63% of other workers.

Source: ABS Australian Health Survey, 2011-12.

Data sources and definitions

This article mainly uses data from the 2011 Census of Population and Housing. It also presents data from previous Censuses for comparison purposes. Rates per 100,000 persons throughout this article are calculated using the usual resident population count from the Census as the denominator.

Occupations are based on the main job held in the week prior to Census night and are coded according to the Australian and New Zealand Standard Classification of Occupations (ANZSCO).

Medical Practitioners diagnose and provide medical care to patients to promote and restore good health. They are divided into generalists and specialists.

Generalist medical practitioners have a Bachelor degree or higher and at least one year of hospital based training. In this article they are referred to as General Practitioners (GPs).

Specialists are medical practitioners who specialise in a particular field of medicine. They generally undergo two years of hospital-based training and at least five years specialist study and training in addition to a Bachelor degree in medicine.In the 2011 Australian Census of Population and Housing there were a further 1,400 medical practitioners who could not be classified as either a GP or specialist. These medical practitioners are included in total counts of doctors, but are not otherwise discussed.

In this article, Nurse includes Registered nurses, Midwives, Nurse educators and researchers, and Nurse managers who usually have a Bachelor degree or higher. Also included in this category are Enrolled and mothercraft nurses who usually have a Diploma or above and work under the supervision of a registered nurse or midwife. In the 2011 Australian Census of Population and Housing there were a further 352 midwifery and nursing professionals who were outside of this article's classification of registered nurse, enrolled nurse and midwives. These midwifery and nursing professionals are included in total counts of nurses, but are not otherwise discussed.

The median age is the age at which half the population is older and half is younger.

Remoteness is determined by measuring the physical road distance to different classes of service centres. Different non-contiguous geographic areas which share common characteristics of remoteness are then grouped together into five categories or remoteness areas: Major Cities, Inner Regional, Outer Regional, Remote and Very Remote. For more information on these geographic classifications, see Australian Statistical Geography Standard (ASGS) (cat. no. 1270.0.55.005).

Earnings: The average weekly cash earnings (including overtime) of full-time adult non-managerial employees are used to examine earnings of health workers. These are sourced from the 2012 ABS Survey of Employee Earnings and Hours.

Alcohol consumption was measured by calculating a 7 day average based on the most recent three days in the previous week when alcohol was consumed. For more information see Australian Health Survey: Users' Guide, 2011-13 (cat. no. 4363.0.55.001).

The Body Mass Index is a measure of overweight and obesity calculated where the weight in kilograms is divided by the square of the height in metres. Values of less than 18.5 are considered underweight, 18.5 to less than 25 are considered normal, 25 to less than 30 are considered overweight, and values of 30 or more are considered obese.